MEDICARE: INTERNATIONAL COMMUNITY HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	600436519	WA
2	251B00000X	Case Management Agency
3	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902983109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL COMMUNITY HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 3007
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98114-3007
Country	:	US
Telephone Number	:	206-788-3600
Fax Number	:	206-652-5216

Provider Business Practice Location Address
First Line	:	3815 S OTHELLO ST
Second Line	:	2ND FLOOR
City	:	SEATTLE
State	:	WA
Zip	:	98118-3510
Country	:	US
Telephone Number	:	206-788-3500
Fax Number	:	206-788-3521

Authorized Official
Title or Position	:	CFO
Name	:	HERMES SHAHBAZIAN
Credential	:
Telephone Number	:	206-788-3618

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/07/2021

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Directions to “INTERNATIONAL COMMUNITY HEALTH SERVICES ” Practice Location

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